Resultados de cirugía resectiva colorrectal por Endometriosis Infiltrante Profunda: 6 años de experiencia

Objetivo: Describir los resultados tempranos de la cirugía resectiva colorrectal por Endometriosis Infiltrante Profunda (EIP) en mujeres intervenidas en centro clínico privado, durante los últimos 6 años. Material y Método Estudio transversal que muestra la evolución clínica de pacientes intervenidas quirúrgicamente con resecciones colorrectales por diagnóstico de (EIP), entre los años 2016-2022 en Clínica Indisa. Se agruparon en resecciones discoidales (Grupo I) y segmentarias (Grupo II) Resultados: De los pacientes operados por (EIP) entre los años 2016 al 2022, 160 pacientes fueron sometidas a resecciones colorrectales, 56 en el Grupo I y 104 en el grupo II. Las características demográficas de ambos grupos fueron similares, con excepción del hábito tabáquico que mostró un predominio en el Grupo II. El análisis de las variables quirúrgicas (tipo de abordaje, tasa de conversión, altura de la anastomosis y ostomía de protección) mostró una distribución similar en ambos grupos. En relación a la evolución postoperatoria, el Grupo I presentó una disminución significativa en el tiempo de realimentación con sólidos de 2 vs 3 días (p = 0,001). El inicio del tránsito intestinal, días de hospitalización y presencia de complicaciones Clavien-Dindo > = 3, no presentó diferencias significativas entre ambos grupos. Discusión: La endometriosis afecta, significativamente, a mujeres en todo el mundo, existiendo escasa evidencia que reporte los resultados de las cirugías colorrectales que comparen ambas técnicas, demostrando que el manejo en centros especializados tiene mejores resultados. Conclusión: Al comparar estas dos técnicas de resección colorrectal en DIE, concluimos que los pacientes operados por resección discoidal tienen una realimentación más temprana sin diferencias significativas en el resto de las variables estudiadas.

Objective: To describe the early outcomes of resective colorectal surgery for Deep Infiltrating Endometriosis (DIE) in women treated at private center over the past 6 years. Materials and Methods: This cross-sectional study presents the clinical evolution of surgically treated patients with colorectal resections for DIE diagnosis between 2016 and 2022 at Clínica INDISA. They were grouped into discoid resections (Group I) and segmental resections (Group II). Results: Of patients operated for DIE between 2016 and 2022, 160 underwent colorectal resections, with 56 in Group I and 104 in Group II. The demographic characteristics of both groups were similar, except for smoking habits, which showed a predominance in Group II. The analysis of surgical variables (approach type, conversion rate, anastomotic height, and protective ostomy) showed a similar distribution in both groups. Regarding postoperative outcomes, Group I showed a significant decrease in solid food resumption time, 2 vs 3 days (p = 0.001). The initiation of intestinal transit, hospitalization days, and presence of Clavien-Dindo complications >= 3 did not present significant differences between both groups. Discussion: Endometriosis significantly affects women worldwide, with limited evidence reporting colorectal surgery outcomes comparing both techniques, demonstrating that management in specialized centers yields better results. Conclusion: When comparing these two techniques of colorectal resection in DIE, we conclude that patients undergoing discoid resection have an earlier resumption of solid food intake without significant differences in the remaining studied variables.

Genomic analysis of inbreeding level, kinship and breed relationships in Creole cattle from South America.

The conservation of animal genetic resources refers to measures taken to prevent the loss of genetic diversity in livestock populations, including the protection of breeds from extinction. Creole cattle populations have suffered a drastic reduction in recent decades owing to absorbent crosses or replacement with commercial breeds of European or Indian origin. Genetic characterization can serve as a source of information for conservation strategies to maintain genetic variation. The objective of this work was to evaluate the levels of inbreeding and kinship through the use of genomic information. A total of 903 DNAs from 13 cattle populations from Argentina, Bolivia and Uruguay were genotyped using an SNP panel of 48 K. Also, a dataset of 76 K SNPs from Peruvian Creole was included. Two inbreeding indices (FROH and Fhat2) and kinship relationships were calculated. In addition, effective population size (Ne), linkage disequilibrium, population composition and phylogenetic relationships were estimated. In Creole cattle, FROH ranged from 0.14 to 0.03, and Fhat2 was close to zero. The inferred Ne trends exhibited a decline toward the present for all populations, whereas Creole cattle presented a lower magnitude of Ne than foreign breeds. Cluster analysis clearly differentiated the taurine and Zebu components (K2) and showed that Bolivian Creole cattle presented Zebu gene introgression. Despite the population reduction, Creole populations did not present extreme values of consanguinity and kinship and maintain high levels of genetic diversity. The information obtained in this work may be useful for planning conservation programmes for these valuable local animal genetic resources.

[Anterior knee pain: a simplified assessment and management algorithm]. / Dolor anterior de rodilla: algoritmo simplificado de estudio y manejo.

Anterior knee pain is a common condition that affects adolescent and young adult patients, being one of the most challenging consultations for a knee surgeon. The large number of distinct diagnoses makes it a peculiar syndrome, the only similarities being the presence of retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. From a pathophysiological perspective, an overuse injury should be considered, where the structural unit of the tissue is damaged or its capacity for reparative response is exceeded. The diagnosis is clinical. Images should be reserved for a particular group of patients. Early intervention is essential to achieve favorable results. Conservative treatment is the gold standard and it is based on multimodal management validated by international consensus. Based on a categorization by clinic and images, we can have a guide to those etiologies that are susceptible to surgical management. The goal of the intervention is to reduce joint stress. The present review defines a simplified algorithm for the study and management of anterior knee pain.

El dolor anterior de rodilla es una condición que afecta a pacientes adolescentes y adultos jóvenes, siendo una de las consultas más comunes y desafiantes para el cirujano de rodilla. La gran cantidad de diagnósticos diferenciales, lo convierten en un síndrome particular, que solo presentan en común la presencia de dolor retro o peripatelar agravado por al menos una actividad que cargue la articulación en flexión. Desde un punto de vista fisiopatológico, debe considerarse una lesión por sobrecarga, donde la unidad estructural del tejido se encuentra dañada o excedida su capacidad de respuesta reparadora. El diagnóstico es clínico. Las imágenes debiesen reservarse para un grupo particular de pacientes. La intervención precoz es fundamental para lograr resultados favorables. El tratamiento conservador es el estándar de oro y se basa en un manejo multimodal validado por consensos internacionales. Basados en una categorización por clínica e imágenes, podemos tener una guía de aquellos cuadros que son susceptibles de manejo quirúrgico. El objetivo de la intervención es reducir el estrés articular. La presente revisión define un algoritmo simplificado de estudio y manejo en dolor anterior de rodilla.

Donor Age Influences Graft-Versus-Host Disease Relapse-Free Survival after Allogeneic Stem Cell Transplant in Elderly Patients in Two Countries from Latin America.

BACKGROUND AND OBJECTIVES: Allogeneic stem cell transplantation (Allo-SCT) in elderly patients is a growing practice. We aimed to determine the graft-versus-host disease (GVHD) relapse-free survival (GRFS) in patients ≥65 years who underwent Allo-SCT in two countries from Latin America. PATIENTS AND METHODS: We performed a retrospective analysis of patients ≥65 years who underwent Allo-SCT in Argentina and Brazil from 2007 to 2019. RESULTS: Ninety-eight patients were evaluated, with primary diagnoses of acute myeloid leukemia and myelodysplastic syndrome; 30% of patients had a hematopoietic cell transplant-comorbidity index (HCT-CI) score ≥3 and 49% were in complete remission. Donor types included matched sibling (n = 41), matched unrelated (n = 31), and haploidentical (HID; n = 26) donors. The conditioning regimen was myeloablative in 28 patients (14 busulfan pharmacokinetically [PK]-guided) and reduced-intensity in 70 patients. The two-year non-relapse mortality (NRM) was 29%, with a higher NRM in melphalan-based compared to other conditionings (51% vs. 33%, p = 0.02). The two-year relapse rate was 24%, with a reduction in PK-guided busulfan (0% vs. 28%, p = 0.03). The two-year overall survival (OS) and GRFS was 52% and 38%, respectively, with a significant reduction in GRFS in HCT-CI ≥3 (27% vs. others 42%, p = 0.02) and donors ≥40 years (29% vs. <40 years 55%, p = 0.02). These variables remained significantly associated with GRFS after multivariate analysis. CONCLUSION: In this cohort of elderly patients from Argentina and Brazil undergoing Allo-SCT, donor age and comorbidities significantly influenced GRFS. The role of the conditioning regimen in this population deserves further investigation.

Dolor anterior de rodilla: algoritmo simplificado de estudio y manejo / Anterior knee pain: a simplified assessment and management algorithm

Resumen: El dolor anterior de rodilla es una condición que afecta a pacientes adolescentes y adultos jóvenes, siendo una de las consultas más comunes y desafiantes para el cirujano de rodilla. La gran cantidad de diagnósticos diferenciales, lo convierten en un síndrome particular, que solo presentan en común la presencia de dolor retro o peripatelar agravado por al menos una actividad que cargue la articulación en flexión. Desde un punto de vista fisiopatológico, debe considerarse una lesión por sobrecarga, donde la unidad estructural del tejido se encuentra dañada o excedida su capacidad de respuesta reparadora. El diagnóstico es clínico. Las imágenes debiesen reservarse para un grupo particular de pacientes. La intervención precoz es fundamental para lograr resultados favorables. El tratamiento conservador es el estándar de oro y se basa en un manejo multimodal validado por consensos internacionales. Basados en una categorización por clínica e imágenes, podemos tener una guía de aquellos cuadros que son susceptibles de manejo quirúrgico. El objetivo de la intervención es reducir el estrés articular. La presente revisión define un algoritmo simplificado de estudio y manejo en dolor anterior de rodilla.

Abstract: Anterior knee pain is a common condition that affects adolescent and young adult patients, being one of the most challenging consultations for a knee surgeon. The large number of distinct diagnoses makes it a peculiar syndrome, the only similarities being the presence of retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. From a pathophysiological perspective, an overuse injury should be considered, where the structural unit of the tissue is damaged or its capacity for reparative response is exceeded. The diagnosis is clinical. Images should be reserved for a particular group of patients. Early intervention is essential to achieve favorable results. Conservative treatment is the gold standard and it is based on multimodal management validated by international consensus. Based on a categorization by clinic and images, we can have a guide to those etiologies that are susceptible to surgical management. The goal of the intervention is to reduce joint stress. The present review defines a simplified algorithm for the study and management of anterior knee pain.

Hematoma espontáneo de la vaina de los rectos en paciente con COVID-19 y leucemia mieloide crónica. Reporte de un caso clínico y revisión de la literatura

Introducción: El hematoma de la vaina de los rectos es poco frecuente. En este reporte se presenta un caso clínico de este cuadro en un paciente con neumonía por COVID-19 y leucemia mieloide crónica, junto con una revisión de literatura. Caso Clínico: Paciente masculino de 55 años, hospitalizado por neumonía por COVID-19 y leucemia mieloide crónica, presenta taquicardia, hipotensión y aumento de volumen abdominal asimétrico. En la tomografía computarizada se evidencia un hematoma de la vaina de los rectos. Se realiza drenaje quirúrgico y control del sangrado. No presentó complicaciones postoperatorias ni necesidad de reoperación. Discusión: Las complicaciones hemorrágicas en pacientes con COVID-19 están poco descritas. El sangrado es una posible complicación en pacientes con leucemia mieloide crónica. Es relevante tener en cuenta el hematoma de la vaina de los rectos en pacientes con COVID-19 y/o leucemia mieloide crónica que presenten aumento de volumen abdominal, para un manejo precoz por un equipo multidisciplinario. Conclusión: La vigilancia activa y el alto índice de sospecha son clave para identificar posibles complicaciones hemorrágicas en pacientes con COVID-19 y/o leucemia mieloide crónica.

Introduction: Rectus sheath hematoma is a rare entity. This report presents a clinical case of a rectus sheath hematoma in a patient with COVID-19 pneumonia and chronic myeloid leukemia, along with a review of the literature. Case Report: A 55-year-old male patient, hospitalized for COVID-19 pneumonia and chronic myeloid leukemia, presents with tachycardia and hypotension. Computed tomography shows a rectus sheath hematoma. Surgical management was performed to control bleeding and drainage of the hematoma. There were no postoperative complications or need for reoperation. Discussion: Hemorrhagic complications in patients with COVID-19 are seldomly reported. Bleeding is a possible complication in patients with chronic myeloid leukemia. It is important to take into account rectus sheath hematoma in patients with COVID-19 and/or chronic myeloid leukemia who present with abdominal pain, for early management by a multidisciplinary team. Conclusion: Active surveillance and a high index of suspicion are key to identifying potential bleeding complications in patients with COVID-19 and/or chronic myeloid leukemia.

Circulating galectin-1 delineates response to bevacizumab in melanoma patients and reprograms endothelial cell biology.

Blockade of vascular endothelial growth factor (VEGF) signaling with bevacizumab, a humanized anti-VEGF monoclonal antibody (mAb), or with receptor tyrosine kinase inhibitors, has improved progression-free survival and, in some indications, overall survival across several types of cancers by interrupting tumor angiogenesis. However, the clinical benefit conferred by these therapies is variable, and tumors from treated patients eventually reinitiate growth. Previously we demonstrated, in mouse tumor models, that galectin-1 (Gal1), an endogenous glycan-binding protein, preserves angiogenesis in anti-VEGF-resistant tumors by co-opting the VEGF receptor (VEGFR)2 signaling pathway in the absence of VEGF. However, the relevance of these findings in clinical settings is uncertain. Here, we explored, in a cohort of melanoma patients from AVAST-M, a multicenter, open-label, randomized controlled phase 3 trial of adjuvant bevacizumab versus standard surveillance, the role of circulating plasma Gal1 as part of a compensatory mechanism that orchestrates endothelial cell programs in bevacizumab-treated melanoma patients. We found that increasing Gal1 levels over time in patients in the bevacizumab arm, but not in the observation arm, significantly increased their risks of recurrence and death. Remarkably, plasma Gal1 was functionally active as it was able to reprogram endothelial cell biology, promoting migration, tubulogenesis, and VEGFR2 phosphorylation. These effects were prevented by blockade of Gal1 using a newly developed fully human anti-Gal1 neutralizing mAb. Thus, using samples from a large-scale clinical trial from stage II and III melanoma patients, we validated the clinical relevance of Gal1 as a potential mechanism of resistance to bevacizumab treatment.

Mechanical ventilation in SARS-CoV-2 patients: state of art / Ventilación mecánica en pacientes con SARS - CoV-2: estado del arte

Abstract CoVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.

Resumen La infección asociada a COVID-19 produce una patología de comportamiento aún desconocido, planteándole diversos desafíos al clínico. Para esta revisión narrativa se llevó a cabo una extensa búsqueda basada en artículos de revisión sobre la infección por SARS-CoV-2 y estudios que incluían estrategias de manejo con ventilación mecánica. El tratamiento basado en evidencia para la infección por SARS-CoV2 todavía está en desarrollo. Tenemos algunas herramientas basadas en nuestros conocimientos de experiencias en el pasado que indican que se debe usar un abordaje escalonado, sin descuidar otras medidas terapéuticas conjuntas para mejorar los desenlaces clínicos de una condición con una elevada mortalidad. Las actuales recomendaciones indican que los pacientes con falla respiratoria aguda por SARS-CoV-2 deben manejarse con medidas de protección con ventilación mecánica. Aún no tenemos una sólida evidencia sobre la individualización del tratamiento con ventilación mecánica, de acuerdo a los distintos fenotipos.

Untangling Galectin-Mediated Circuits that Control Hypoxia-Driven Angiogenesis.

Development of an aberrant vascular network is a hallmark of the multistep pathological process of tumor growth and metastasis. In response to hypoxia, several pro-angiogenic factors are synthesized to support vascularization programs required for cancer progression. Emerging data indicate the involvement of glycans and glycan-binding proteins as critical regulators of vascular circuits in health and disease. Galectins may be regulated by hypoxic conditions and control angiogenesis in different physiopathological settings. These ß-galactoside-binding proteins may promote sprouting angiogenesis by interacting with different glycosylated receptors and triggering distinct signaling pathways. Understanding the role of galectins in tumor neovascularization will contribute to the design of novel anti-angiogenic therapies aimed at complementing current anti-cancer modalities and overcoming resistance to these treatments. Here we describe selected strategies and methods used to study the role of hypoxia-regulated galectins in the regulation of blood vessel formation.

Using CDOM spectral shape information to improve the estimation of DOC concentration in inland waters: A case study of Andean Patagonian Lakes.

For the last two decades different scientific disciplines have focused on lacustrine dissolved organic matter (DOM) given its importance in the biogeochemistry of carbon and in ecosystem functioning. New satellites supply the appropriate resolutions to evaluate chromophoric dissolved organic matter (CDOM) in inland waters, opening the possibility to estimate DOM at appropriate spatiotemporal scales. This requires, however, a robust relationship between CDOM and dissolved organic carbon (DOC). In this work, we evaluated the use of CDOM as a proxy of DOC in 7 Andean Patagonian lakes. Considering the entire data set, CDOM absorption coefficients (a355 and a440) were linearly related with DOC. Shallow lakes, however, drove this relationship showing a moderate relationship, whereas, deep lakes with lower colour presented a weaker relationship. Therefore, we assessed the use of CDOM spectral shape information to improve DOC estimates regardless of observed DOM differences due to climatic seasonality and lakes' morphometry. The use of well-known CDOM spectral shape metrics (i.e., S275-295 and a250:a365 ratio) significantly improved DOC estimation. Particularly, using a Gaussian decomposition approach we found that much of the variation in the spectral shape, associated with the variability of CDOM:DOC ratio, was explained by differences in two dynamic regions centred at 270 and 320 nm. A strong nonlinear relationship was found between the a270:a320 ratio and the DOC-specific absorption coefficients a*355 and a*440. This was translated into a further improvement in DOC estimation yielding the higher R2 and lower mean absolute differences (MAPD < 16%), either considering the entire data set or shallow and deep lakes separately. Our results highlight that incorporating the CDOM spectral shape information improves the characterization of the DOC pool of inland waters, which is particularly relevant for remote and/or inaccessible sites and has significant implications for the environmental management, biogeochemical studies and future remote sensing applications.

Analysis of a Fast Control Allocation approach for nonlinear over-actuated systems.

Autonomous Robots with multiple directional thrusters are normally over-actuated systems that require nonlinear control allocation methods to map the forces that drive the robot's dynamics and act as virtual control variables to the actuators. This process demands computational efforts that, sometimes, are not available in small robotic platforms. The present paper introduces a new control allocation approach with fast convergence, high accuracy, and dealing with complex nonlinear problems, especially in embedded systems. The adopted approach divides the desired nonlinear system into coupled linear problems. For that purpose, the Real Actions (RAs) and Virtual Control Variables (VCVs) are broke in two or more sets each. While the RA subsets are designed to linearize the system according to different input subspaces, the VCV is designed to be partially coupled to overlap the output subspaces. This approach generates smaller linear systems with fast and robust convergence used sequentially to solve nonlinear allocation problems. This methodology is assessed in mathematical tutorial cases and over-actuated UAV simulations.

Portable single-lead electrocardiogram device is accurate for QTc evaluation in hospitalized patients.

BACKGROUND: Many commonly used drugs can prolong the QTc interval (QTc), which can lead to potentially life-threatening arrhythmias. In the current era of the COVID-19 pandemic, it is worth mentioning that the disease itself and several drugs used for its treatment have been associated with QTc prolongation. OBJECTIVE: To evaluate the agreement and clinical precision of a portable single-lead electrocardiogram (ECG) device to measure the QTc interval compared to the standard 12-lead ECG. METHODS: In sequential tests, QTc of ECG recordings obtained with the KardiaMobile (KM-1L) device (AliveCor, San Francisco, CA) were compared to QTc obtained with conventional 12-lead ECG. Agreement was evaluated using Bland-Altman plots and Lin's concordance coefficient. Consistency between the 2 devices in determining QTc prolongation (QTc ≥470 ms in males or ≥480 ms in females) was evaluated with kappa statistics. RESULTS: A total of 128 patients with a presumed or confirmed diagnosis of COVID-19 admitted to a university hospital were included. QTc intervals measured with KM-1L were similar to QTc measured with conventional ECG (442.45 ± 40.5 vs 441.65 ± 40.3 ms, P = .15). Bland-Altman analysis showed no significant difference in QTc values (average difference of -0.797, 95% limits of agreement:-13.179; 11.585). Lin's concordance coefficient showed an excellent agreement (0.988, P < .001). Concordance between the 2 devices for determining QTc prolongation was excellent (kappa >0.90). CONCLUSION: ECG recordings obtained with KM-1L allow an accurate QTc interval assessment. Considering its simplicity of use, this approach has advantages over conventional ECG and can provide an alternative for the evaluation of QTc in hospitalized patients, during the current time of the COVID-19 pandemic and beyond.

The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP).

PURPOSE: Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates. METHODS: Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020. RESULTS: Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions. CONCLUSIONS: The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.

Challenges in early phase clinical trials for childhood cancer during the COVID-19 pandemic: a report from the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP).

PURPOSE: The COVID-19 pandemic has forced healthcare stakeholders towards challenging decisions. We analyse the impact of the pandemic on the conduct of phase I-II trials for paediatric cancer during the first month of state of alarm in Spain. METHODS: A questionnaire was sent to all five ITCC-accredited Spanish Paediatric Oncology Early Phase Clinical Trial Units, including questions about impact on staff activities, recruitment, patient care, supply of investigational products, and legal aspects. RESULTS: All units suffered personnel shortages and difficulties in enrolling patients, treatment continuity, or performing trial assessments. Monitoring activity was frequently postponed (73%), and 49% of on-going trials interrupted recruitment. Only two patients could be recruited during this period (75% reduction in the expected rate). CONCLUSIONS: The COVID-19 crisis has significantly impacted clinical research practice and access to innovation for children with cancer. Structural and functional changes are under way to better cope with the expected future restrictions.

Incertidumbre y afrontamiento en familiares de personas dependientes del alcohol: apoyo social y espiritualidad / Uncertainty and coping among relatives of alcohol dependent persons: social support and spirituality / Incerteza e enfrentamento em parentes de pessoas dependentes de álcool: apoio social e espiritualidade

Resumen Introducción: La dependencia al alcohol, considerada como una enfermedad crónica, es un detonante de incertidumbre para el familiar de la persona con dependencia, lo cual genera trastornos emocionales negativos. El apoyo social y la espiritualidad son mecanismos de afrontamiento que podrían disminuir la incertidumbre y favorecer el bienestar tanto físico, como psicológico. Objetivos: Determinar la relación y el efecto del apoyo social y la espiritualidad sobre la incertidumbre del familiar de la persona dependiente del alcohol. Métodos: Estudio descriptivo y correlacional, muestra de 135 mujeres pertenecientes a grupos Al-Anon, se utilizaron la Escala de Percepción de Incertidumbre en Padres y Miembros de la Familia (PPUS-FM) de Mishel, el cuestionario MOS-SSS de Sherbourne y Stewart y la Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Se identificó un coeficiente de correlación negativo y significativo de la incertidumbre con el apoyo social (r s= -.356, p <.01) y la espiritualidad (r s= -.216, p <.05). Mediante un modelo de regresión lineal general univariado se determinó que únicamente el apoyo social influye en la disminución de la incertidumbre (β= -.280, t= -3.62, p= .001) con un coeficiente de determinación o varianza explicada del 11.5%, mientras que la espiritualidad no mostró efecto (β= -.041, t= .218, p >.05) sobre la incertidumbre. Conclusiones: El apoyo social es identificado como un mecanismo de afrontamiento efectivo que permitirá al personal de enfermería desarrollar intervenciones dirigidas a reducir la incertidumbre en familiares de personas con algún tipo de dependencia.

Abstract Introduction: Alcohol dependency is a chronic illness which generates uncertainty and other emotional problems among the relatives of persons who suffer alcoholism. Social support and spirituality are some coping mechanisms which could reduce uncertainty and favor the physical and psychological wellbeing. Objective: To determine the relationship and the effect of social support and spirituality on the uncertainty experienced by relatives of alcohol dependent persons. Methods: This is a descriptive and correlational study. The sample was constituted by 135 women members of Al-Anon. The Mishel Scale of Perception of Uncertainty among Parents and Family Members (PPUS-FM), the Sherbourne and Stewart Questionnaire, and the Reed Spiritual Perspective Scale were all used. Results: Significant negative correlation coefficients between uncertainty and social support (r s= -.356, p .05). and spirituality (r s= -.216, p .05). were identified. Using a univariate general linear regression model, it was determined that only social supports reduced uncertainty (β= -.280, t= -3.62, p= .001) with 11.5% of variance explained; while spirituality did not produce any effect (β = -.041, t= .218, p >.05). Conclusions: Social support is identified as a coping mechanism which can be used by nursing staff to develop interventions aimed at reducing uncertainty among relatives of alcohol dependent persons.

Resumo Introdução: A dependência do álcool, considerada como uma doença crónica, é um gatilho de incerteza para o familiar da pessoa com dependência, o qual gera transtornos emocionais negativos. O suporte social e a espiritualidade são mecanismos de enfrentamento que poderiam diminuir a incerteza e favorecer o bem-estar tanto físico, quanto psicológico. Objetivos: Determinar a relação e o efeito do suporte social e a espiritualidade sobre a incerteza do familiar da pessoa dependente de álcool. Métodos: Estudo descritivo e correlacional, amostra de 135 mulheres pertencentes aos grupos Al-Anon, utilizaram-se a Escala de Percepção de Incerteza em Pais e Membros da Família (PPUS-FM) de Mishel, o questionário MOS-SSS de Sherbourne e Stewart e a Escala de Perspectiva Espiritual elaborada por Reed. Resultados: Identificou-se um coeficiente de correlação negativo e significativo da incerteza com o apoio social (r s= -.356, p <.01) e a espiritualidade (r s= -.216, p <.05). Mediante um modelo de regressão linear geral univariado determinou-se que unicamente o apoio social influencia a diminuição da incerteza (β= -.280, t= -3.62, p= .001) com um coeficiente de determinação ou variância explicada do 11.5%, enquanto a espiritualidade não mostrou efeito (β= -.041, t= .218, p >.05) sobre a incerteza. Conclusões: O suporte social é identificado como um mecanismo de enfrentamento eficaz que permitirá ao pessoal de enfermagem desenvolver intervenções dirigidas a reduzir a incerteza em familiares de pessoas com algum tipo de dependência.

Nanoparticulated Systems Based on Natural Polymers Loaded with Miconazole Nitrate and Lidocaine for the Treatment of Topical Candidiasis.

People with weakened immune systems are at risk of developing candidiasis which is a fungal infection caused by several species of Candida genus. In this work, polymeric nanoparticles containing miconazole nitrate and the anesthetic lidocaine clorhydrate were developed. Miconazole was chosen as a typical drug to treat buccopharyngeal candidiasis whereas lidocaine may be useful in the management of the pain burning, and pruritus caused by the infection. Nanoparticles were synthesized using chitosan and gelatin at different ratios ranging from 10:90 to 90:10. The nano-systems presented nanometric size (between 80 and 300 nm in water; with polydispersion index ranging from 0.120 to 0.596), and positive Z potential (between 20.11 and 37.12 mV). The determined encapsulation efficiency ranges from 65 to 99% or 34 to 91% for miconazole nitrate and lidocaine clorhydrate, respectively. X-ray diffraction and DSC analysis suggested that both drugs were in amorphous state in the nanoparticles. Finally, the systems fitted best the Korsmeyer-Peppas model showing that the release from the nanoparticles was through diffusion allowing a sustained release of both drugs and prolonged the activity of miconazole nitrate over time against Candida albicans for at least 24 h.

Thermal Degradation Kinetics of ZnO/polyester Nanocomposites.

ZnO particles were synthetized by the sol-gel method and subsequent heat treatment of 400, 500 and 600 °C was applied. The nano ZnO particles were incorporated to the unsaturated polyester resin by solution blending at 0.05 wt % concentration. X-ray diffraction detected the formation of a wurtzite-like structure. Viscoelastic behavior of neat polyester and nanocomposites revealed the nano ZnO particles does not promote better mechanical properties because of a weak interaction and the glass transition temperature of the polyester was favored by the presence of a higher quantity of nano-size ZnO particles. Thermogravimetric analysis at 5, 10 and 20 °C/min allowed determining the degradation kinetic parameters based on the Friedman and Kissinger models for neat polyester and nanocomposites. Heating rates promoted an increase in the temperature degradation and the addition of ZnO particles promoted a catalyst effect that reduce the amount of thermal energy needed to start the thermal degradation.

Virulence of Metarhizium brunneum (Ascomycota: Hypocreales) Strains Against Stinkbugs Euschistus heros and Dichelops furcatus (Hemiptera: Pentatomidae).

Three strains of fungi belonging to the genus Metarhizium Sorokin (ARSEF 4556, ARSEF 3297, native strain) were assayed against adults and nymphs of the Neotropical brown stinkbug Euschistus heros (F.) and the green-belly stinkbug Dichelops furcatus (F.). The most virulent strain, ARSEF 4556, caused over 90% mortality. The average survival time of the second and fifth instar nymphs and adults following immersion in 1 × 108 conidia ml-1 was 4.8, 5.7, and 5.2 d, respectively. The second instar nymphs were more susceptible than the adults. The LC50 values and median survival times for second instar and adult E. heros were 1.6 × 107 and 3.1 × 107 conidia ml-1 and 6 and 8 d, respectively. Eggs of E. heros and the closely related stinkbug, D. furcatus, were highly susceptible to ARSEF 4556 with the mean mortality of eggs immersed in 1 × 108 conidia ml-1 being 77.4% and 89.7%, respectively. The strain 3297 showed also good aptitudes for stinkbugs control with mortalities higher than 80% against nymphs and adults and eggs mortalities of 75.5% for E. heros and 79.6% for D. furcatus. This study has shown that it is possible to have a two-pronged control strategy, targeting adults and to reduce oviposition and targeting egg clusters to prevent emergence and dispersal of nymphs. Besides early instars of nymphs have been shown to be more susceptible to the fungal strains than late instars and adults.

ECO-SEOM-SEEO safety recommendations guideline for cancer patients receiving intravenous therapy.

PURPOSE: Cancer patients require implantation of venous access devices to meet their personalized therapeutic needs, which are often complex due to the nature of the medication and the disease status. Therefore, it is essential to have standardized protocols that guarantee the best results in health and patient safety. METHODS: To learn about the availability of protocols and aspects related to safety in clinical practice and to detect possible opportunities for improvement, a survey has been conducted in various Spanish hospitals, in addition to a review of the evidence regarding the various devices available and complications associated with the administration of chemotherapy. RESULTS: As a result of both analyses, the Foundation for Excellence and Quality in Oncology (ECO), the Spanish Society of Medical Oncology (SEOM), and the Spanish Society of Oncology Nursing (SEEO) have developed a catheter selection algorithm based on patient characteristics and treatment to facilitate the clinical decision-making process, as well as some recommendations aimed at ensuring patient safety and rational use of available resources. CONCLUSIONS: In conclusion, both the venous access catheter selection algorithm and the proposed recommendations aim to respond to the needs revealed in clinical practice and to become an integrable tool in electronic prescription systems to offer homogeneous criteria for action in cancer patients that require venous access, optimizing the use of available health resources with the highest safety and quality of life for the patient.